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    1. Improving Access—but Not Outcomes—With Iris Optical Coherence Tomography Angiography

      Improving Access—but Not Outcomes—With Iris Optical Coherence Tomography Angiography

      Throughout the past 2 decades, the exquisite, real-time ocular imaging attainable with optical coherence tomography (OCT) has transformed the practice of ophthalmology. Further increases in processing speed have led to the introduction of OCT angiography (OCT-A). 1 Preliminary work has shown that it is possible to use OCT-A to characterize the vasculature of the iris. 1 The current standard for assessing anterior segment circulation is iris angiography, but this approach has substantial drawbacks, most notably the need to administer an intravenous contrast agent, such as fluorescein or indocyanine green. In this issue of JAMA Ophthalmology , Velez and colleagues 2 explore ...

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    2. Association of Retinal Nerve Fiber Layer Thinning With Current and Future Cognitive Decline A Study Using Optical Coherence Tomography

      Association of Retinal Nerve Fiber Layer Thinning With Current and Future Cognitive Decline A Study Using Optical Coherence Tomography

      Importance Identifing potential screening tests for future cognitive decline is a priority for developing treatments for and the prevention of dementia. Objective To examine the potential of retinal nerve fiber layer (RNFL) thickness measurement in identifying those at greater risk of cognitive decline in a large community cohort of healthy people. Design, Setting, and Participants UK Biobank is a prospective, multicenter, community-based study of UK residents aged 40 to 69 years at enrollment who underwent baseline retinal optical coherence tomography imaging, a physical examination, and a questionnaire. The pilot study phase was conducted from March 2006 to June 2006, and ...

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    3. Association of Retinal Neurodegeneration on Optical Coherence Tomography With Dementia: A Population-Based Study

      Association of Retinal Neurodegeneration on Optical Coherence Tomography With Dementia: A Population-Based Study

      Importance Retinal structures may serve as a biomarker for dementia, but longitudinal studies examining this link are lacking. Objective To investigate the association of inner retinal layer thickness with prevalent and incident dementia in a general population of Dutch adults. Design, Setting, and Participants From September 2007 to June 2012, participants from the prospective population-based Rotterdam Study who were 45 years and older and had gradable retinal optical coherence tomography images and at baseline were free from stroke, Parkinson disease, multiple sclerosis, glaucoma, macular degeneration, retinopathy, myopia, hyperopia, and optic disc pathology were included. They were followed up until January ...

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    4. Optical Coherence Tomography Angiography to Evaluate Ischemia in Diabetic Eyes

      Optical Coherence Tomography Angiography to Evaluate Ischemia in Diabetic Eyes

      The retinal vasculature consists of a superficial vascular plexus (SVP), an intermediate capillary plexus (ICP), and a deep capillary plexus (DCP). There is also a fourth regional vascular network, the radial peripapillary capillary plexus (RPCP). The RPCP runs in parallel with the nerve fiber layer, the SVP is located within the ganglion cell layer and the deeper plexuses, and the ICP and DCP are above and below the inner nuclear layer, respectively. The SVP receives a blood supply from the central retinal artery and the deeper vascular layers are supplied by vertical anastomoses from the SVP. 1

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    5. Automated Quantification of Nonperfusion Areas in 3 Vascular Plexuses With Optical Coherence Tomography Angiography in Eyes of Patients With Diabetes

      Automated Quantification of Nonperfusion Areas in 3 Vascular Plexuses With Optical Coherence Tomography Angiography in Eyes of Patients With Diabetes

      Importance Diabetic retinopathy (DR) is a leading cause of vision loss that is managed primarily through qualitative clinical examination of the retina. Optical coherence tomography angiography (OCTA) may offer an objective and quantitative method of evaluating DR. Objective To quantify capillary nonperfusion in 3 vascular plexuses in the macula of eyes patients with diabetes of various retinopathy severity using projection-resolved OCTA (PR-OCTA). Design, Setting, and Participants Cross-sectional study at a tertiary academic center comprising 1 eye each from healthy control individuals and patients with diabetes at different severity stages of retinopathy. Data were acquired and analyzed between January 2015 and ...

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    6. Use of a Binocular Optical Coherence Tomography System to Evaluate Strabismus in Primary Position

      Use of a Binocular Optical Coherence Tomography System to Evaluate Strabismus in Primary Position

      Importance Current clinical methods for assessing strabismus can be prone to error. Binocular optical coherence tomography (OCT) has the potential to assess and quantify strabismus objectively and in an automated manner. Objective To evaluate the use of a binocular OCT prototype to assess the presence and size of strabismus. Design, Setting, and Participants Fifteen participants with strabismus were recruited in 2016 as part of the EASE study from Moorfields Eye Hospital National Health Service Foundation Trust, London, England, and 15 healthy volunteers underwent automated anterior segment imaging using the binocular OCT prototype. All participants had an orthoptic assessment, including alternating ...

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    7. Optical Coherence Tomography Angiography Compared With Optical Coherence Tomography Macular Measurements for Detection of Glaucoma

      Optical Coherence Tomography Angiography Compared With Optical Coherence Tomography Macular Measurements for Detection of Glaucoma

      Importance Whether optical coherence tomography angiography (OCT-A) outperforms OCT to detect glaucoma remains inconclusive. Objective To compare (1) the diagnostic performance for detection of glaucoma and (2) the structure-function association between inner macular vessel density and inner macular thickness. Design, Setting, and Participants This cross-sectional study included 115 patients with glaucoma and 35 healthy individuals for measurements of retinal thickness and retinal vessel density, segmented between the anterior boundary of internal limiting membrane and the posterior boundary of the inner plexiform layer, over the 3 × 3-mm 2 macula using swept-source OCT. All participants were Chinese. Visual sensitivity corresponding to the ...

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    8. Developing Binocular Optical Coherence Tomography for Strabismus Not a Simple Task

      Developing Binocular Optical Coherence Tomography for Strabismus Not a Simple Task

      Optical coherence tomography (OCT) use in ophthalmology continues to increase as more indications for and developments of OCT imaging are described. Optical coherence tomography provides objective, quantitative data that allow an accurate diagnosis and monitoring of eye disease, reducing the variability inherent in subjective patient evaluations. However, the increasing use of OCT in ophthalmology has created a burden to our health care system due to high operating costs. The idea of a compact binocular OCT device that is cheaper to build and patient operated is an attractive idea to reduce costs and improve the efficiency of delivering health care while ...

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    9. Clinical Use of Optical Coherence Tomography Angiography in Diabetic Retinopathy Treatment Ready for Showtime?

      Clinical Use of Optical Coherence Tomography Angiography in Diabetic Retinopathy Treatment Ready for Showtime?

      Diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) are the 2 advanced stages of diabetic retinopathy (DR) that are the main causes for visual loss in patients with diabetes. Both DME and PDR can be readily diagnosed with clinical examination and, increasingly, by the noninvasive use of optical coherence tomography. However, another, less commonly recognized cause of visual loss in patients with diabetes is diabetic macular ischemia (DMI) in the absence of DME. 1 The understanding of the natural history, risk factors, and functional outcomes of DMI remains limited. This is partly because of the long-standing need for invasive ...

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    10. Vitreous Bands Identified by Handheld Spectral-Domain Optical Coherence Tomography Among Premature Infants

      Vitreous Bands Identified by Handheld Spectral-Domain Optical Coherence Tomography Among Premature Infants

      Importance Handheld spectral-domain optical coherence tomography (SD-OCT) can provide insights into the complex interactions occurring at the vitreoretinal interface in retinopathy of prematurity (ROP) to enhance our understanding of ROP pathology. Objective To characterize vitreous bands in premature infants with use of handheld SD-OCT. Design, Setting, and Participants Prospective cohort study conducted from July 7, 2015, to February 28, 2017, at 2 university-based neonatal intensive care units. Seventy-three premature infants who required routine ROP screening examination were recruited. Informed consent was obtained from all legal guardians. Trained graders who were masked to the clinical assessment analyzed each SD-OCT scan of ...

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    11. Multimodal Imaging and Spatial Analysis of Ebola Retinal Lesions in 14 Survivors of Ebola Virus Disease

      Multimodal Imaging and Spatial Analysis of Ebola Retinal Lesions in 14 Survivors of Ebola Virus Disease

      Abstract Importance Differentiation between Ebola retinal lesions and other retinal pathologies in West Africa is important, and the pathogenesis of Ebola retinal disease remains poorly understood. Objective To describe the appearance of Ebola virus disease (EVD) retinal lesions using multimodal imaging to enable inferences on potential pathogenesis. Design, Setting, and Participants This prospective case series study was carried out at 34 Military Hospital in Freetown, Sierra Leone. Ophthalmological images were analyzed from 14 consecutively identified survivors of EVD of Sierra Leonean origin who had identified Ebola retinal lesions. Main Outcomes and Measures Multimodal imaging findings including ultra-widefield scanning laser ophthalmoscopy ...

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    12. Why Do We Still Rely on Ophthalmoscopy to Diagnose Retinopathy of Prematurity?

      Why Do We Still Rely on Ophthalmoscopy to Diagnose Retinopathy of Prematurity?

      There was a time not that long ago when there was equipoise as to whether optical coherence tomography (OCT) could complement the clinical examination in a meaningful way and whether it justified the time and expense for practices focused on adult patients with retinal conditions. In 2018, OCT has become standard equipment and has a critical role in the diagnosis and monitoring of many vitreoretinal diseases. The recent development of OCT angiography (OCTA) may further enhance clinical care. Management paradigms based on OCT have become standard of care for neovascular age-related macular degeneration and diabetic macular edema, 2 of the ...

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    13. Vitreopapillary Traction Detected by Optical Coherence Tomography

      Vitreopapillary Traction Detected by Optical Coherence Tomography

      A man in his 70s was referred for evaluation of a suspected right optic neuropathy. Visual acuity was 20/25 OU, color vision was normal, and there was a trace right relative afferent pupillary defect. Fundus examination revealed an elevated right optic disc with mildly blurred margins and vessel obscuration. Bilateral epiretinal membranes were also present. Optical coherence tomography (Cirrus OCT; Carl Zeiss Meditec, Inc) confirmed the diagnosis of vitreopapillary traction, characterized by an incomplete posterior vitreous detachment or proliferating fibrocellular membrane pulling the optic disc toward the vitreous cavity ( Figure ). 1 Optical coherence tomography is helpful in confirming the ...

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    14. Association of Myopia With Peripapillary Perfused Capillary Density in Patients With Glaucoma An Optical Coherence Tomography Angiography Study

      Association of Myopia With Peripapillary Perfused Capillary Density in Patients With Glaucoma An Optical Coherence Tomography Angiography Study

      Importance This study used optical coherence tomographic angiography to assess for impaired blood flow in myopic eyes with or without open-angle glaucoma. Objective To compare the peripapillary perfused capillary density (PCD) between eyes with and without glaucoma. Design, Setting, and Participants In this cross-sectional study at a tertiary glaucoma referral practice, we recruited patients with myopic eyes of spherical equivalent of more than −3.0 diopters with and without open-angle glaucoma, patients with nonmyopic eyes with glaucoma, and patients with no disease from February 2016 to October 2016. We obtained 4.5 × 4.5-mm optical coherence tomographic angiography images of ...

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    15. Multimodal Retinal Imaging in Incontinentia Pigmenti Including Optical Coherence Tomography Angiography

      Multimodal Retinal Imaging in Incontinentia Pigmenti Including Optical Coherence Tomography Angiography

      Importance Incontinentia pigmenti (IP) is a rare, X-linked dominant disease with potentially severe ocular complications that predominantly affect the peripheral retina. However, little is known about its effects on the macula. Objective To describe the structural and vascular abnormalities observed in the maculas of patients with IP and to correlate these findings with peripheral pathologies. Design, Setting, and Participants Prospective, cross-sectional study at Wilmer Eye Institute, Johns Hopkins University. Five participants with a clinical diagnosis of IP were included and underwent multimodal imaging with ultra–wide-field fluorescein angiography (FA), spectral-domain optical coherence tomography (OCT), and OCT angiography. Main Outcomes and ...

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    16. Nonculprit Plaque Characteristics in Patients With Acute Coronary Syndrome Caused by Plaque Erosion vs Plaque Rupture A 3-Vessel Optical Coherence Tomography Study

      Nonculprit Plaque Characteristics in Patients With Acute Coronary Syndrome Caused by Plaque Erosion vs Plaque Rupture A 3-Vessel Optical Coherence Tomography Study

      Importance Patients with culprit plaque rupture are known to have pancoronary plaque vulnerability. However, the characteristics of nonculprit plaques in patients with acute coronary syndromes caused by plaque erosion are unknown. Objective To investigate the nonculprit plaque phenotype in patients with acute coronary syndrome according to culprit plaque pathology (erosion vs rupture) by 3-vessel optical coherence tomography imaging. Design, Setting, and Participants In this observational cohort study, between August 2010 and May 2014, 82 patients with ACS who underwent preintervention optical coherence tomography imaging of all 3 major epicardial coronary arteries were enrolled at the Massachusetts General Hospital Optical Coherence ...

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    17. Optical Coherence Tomography in Group 2A Idiopathic Juxtafoveolar Retinal Telangiectasis

      Optical Coherence Tomography in Group 2A Idiopathic Juxtafoveolar Retinal Telangiectasis

      Objective To describe the changes observed with optical coherence tomography in group 2A idiopathic juxtafoveolar retinal telangiectasis. Methods We retrospectively reviewed the medical records of 13 patients (25 eyes). All eyes underwent optical coherence tomography examination consisting of 6 radial scans, fundus color photography, and fluorescein angiography. We calculated retinal foveal and central foveal thicknesses from software mapping results. We compared the optical coherence tomography data with fundus photography and fluorescein angiography findings. Results Foveal cystoid spaces, very small or more prominent, were present in 20 of 25 eyes. Some degree of disruption of the inner segment/outer segment photoreceptor ...

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    18. Acute Solar Retinopathy Imaged With Adaptive Optics, Optical Coherence Tomography Angiography, and En Face Optical Coherence Tomography

      Acute Solar Retinopathy Imaged With Adaptive Optics, Optical Coherence Tomography Angiography, and En Face Optical Coherence Tomography

      Importance Solar retinopathy is a rare form of retinal injury that occurs after direct sungazing. Objective To enhance understanding of the structural changes that occur in solar retinopathy by obtaining high-resolution in vivo en face images. Design, Setting, and Participant Case report of a young adult woman who presented to the New York Eye and Ear Infirmary with symptoms of acute solar retinopathy after viewing the solar eclipse on August 21, 2017. Main Outcomes and Measures Results of comprehensive ophthalmic examination and images obtained by fundus photography, microperimetry, spectral-domain optical coherence tomography (OCT), adaptive optics scanning light ophthalmoscopy, OCT angiography ...

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    19. Optical Coherence Tomography Features of Dermatophytoma

      Optical Coherence Tomography Features of Dermatophytoma

      Dermatophytoma was first described in 1998 to complicate toenail infections and is characterized by fungal elements compacted into a fungal ball. 1 Clinically, it appears as a dense white or yellow linear or round white patch within the nail plate. Cutting back the overlying nail plate reveals a hyperkeratotic mass that can be easily removed because it is not adherent to the nail plate or nail bed, and histologic analysis reveals a dense mass of abnormal-appearing, densely walled, dermatophyte hyphae. 1 , 2 The standard diagnostic test for onychomycosis involves clinical suspicion and at least 1 positive finding on a laboratory ...

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    20. En Face Optical Coherence Tomography of Stellate Nonhereditary Idiopathic Foveomacular Retinoschisis

      En Face Optical Coherence Tomography of Stellate Nonhereditary Idiopathic Foveomacular Retinoschisis

      A woman in her 60s presented with 2 months of blurred vision in the left eye, with visual acuity of 20/40. Examination of the left ocular fundus revealed spokelike foveal cysts. Fluorescein angiography showed no foveal leakage. En face optical coherence tomography (Optovue Inc) in the left eye revealed stellate hyporeflectivity ( Figure , A). A retinal cross-section scan revealed foveomacular retinoschisis involving the outer plexiform layer ( Figure , B). The fellow eye was normal. Without evidence of X-linked retinoschisis, niacin or taxane use, enhanced S-cone syndrome, glaucoma, traction, optic pit, or pathologic myopia, the patient was diagnosed as having stellate nonhereditary ...

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    21. Intraoperative Optical Coherence Tomography for Anterior Chamber and Sulcus Positioning

      Intraoperative Optical Coherence Tomography for Anterior Chamber and Sulcus Positioning

      Presence in the anterior chamber can be confirmed by observation of the reflective needle tip. The silicone tube and its lumen can be appreciated when subsequently inserted into the anterior chamber. The presence of the needle in the sulcus can be confirmed by the lack of a signal from the needle and anterior displacement of the iris.

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    22. Use of Intraoperative OCT for Tube Positioning in Glaucoma Surgery

      Use of Intraoperative OCT for Tube Positioning in Glaucoma Surgery

      Intraoperative optical coherence tomography (iOCT) has become a valuable adjunct to ophthalmic surgery in the past decade. Although iOCT has been used extensively in retinal surgery for epiretinal membrane peel and in corneal surgery for lamellar keratoplasty, 1 - 4 its use in surgical procedures for glaucoma remains limited. Dada et al 5 describe the use of iOCT in guiding needling of a trabeculectomy bleb, whereas Siebelmann et al 6 introduced the use of iOCT in canaloplasty. To our knowledge, the utility of iOCT has not been assessed in implantation of glaucoma drainage devices. We herein propose the use of iOCT ...

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    23. Optical Coherence Tomography Angiography for Assessment of the 3-Dimensional Structures of Polypoidal Choroidal Vasculopathy

      Optical Coherence Tomography Angiography for Assessment of the 3-Dimensional Structures of Polypoidal Choroidal Vasculopathy

      Importance Investigating the quantitative 3-dimensional (3-D) anatomy of polypoidal complex is important for a better understanding of the pathogenesis of polypoidal choroidal vasculopathy (PCV). Objective To quantitatively evaluate the 3-D characteristics of polypoidal structures, branching vascular networks (BVNs), and origin of PCV using optical coherence tomography angiography (OCTA) and multiple image systems. Design, Setting, and Participants A prospective, observational study was conducted in 47 consecutive Taiwanese patients (47 eyes) from May 21, 2015, to April 30, 2017. All participants were scanned with the Optovue-RTVue-XR-Avanti OCTA system. Patients in whom PCV was identified on OCTA were examined to define characteristics and ...

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    24. The Role of Optical Coherence Tomography Angiography in Polypoidal Choroidal Vasculopathy

      The Role of Optical Coherence Tomography Angiography in Polypoidal Choroidal Vasculopathy

      Retinal imaging technology has progressed rapidly in recent years and plays increasingly vital roles in guiding the clinical management of retinal diseases, as well as facilitating greater understanding of the disease process. Polypoidal choroidal vasculopathy (PCV) is an important variant of neovascular age-related macular degeneration with distinct phenotypic features that can be seen both on clinical examination and using indocyanine green angiography (ICGA). In this issue of JAMA Ophthalmology, the optical coherence tomography angiography (OCTA) features of PCV are described and evaluated by Chi et al.1

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